Nitrous Oxide Eases Pain, Stress of Difficult Children's Treatments

MADISON - The pleasing aroma of bubble gum, orange or vanilla is changing the way many young patients are sedated for certain medical procedures.

And their doctors say using nitrous oxide, delivered through scented masks, has another big plus: it reduces the stress and the time required for difficult or painful treatments.

Since June, more than 100 patients undergoing sedation at American Family Children's Hospital have received "laughing gas" – nitrous oxide – which they inhale through a scented mask. Only about a dozen hospitals across the country use nitrous oxide for pediatric sedation, but the trend is growing.

Physicians say the new approach is very effective in calming children for certain procedures, such as accessing a port with a needle to give chemotherapy or inserting urethral catheters for children undergoing workup for urinary tract infections. The patient is lightly sedated while breathing the gas and is able to interact with hospital staff.

"It's a nice thing to have the scented masks," says Dr. Greg Hollman, professor of pediatrics at the University of Wisconsin School of Medicine and Public Health. "Kids can inhale their favorite flavor while getting their medication."

Hollman believes the use of nitrous oxide has a number of advantages over oral or intravenous sedatives for children.

"With oral medications it is not uncommon to wait 20 minutes for the sedative to work," he says. "The patient typically would have to stay additional time in the hospital to make sure they were fully recovered from sedation. The advantage nitrous oxide has over oral medications is that it starts working in a minute, and after the procedure the mask is removed, the effects are gone, and the child can go home."

Hollman says this means less stress for families with children who require frequent appointments for chronic illnesses.

"It's not just a matter of how well they recover, but how quickly, especially for cancer patients. They spend enough time in the hospital," he says. "That's really important to a family - anything to ease their situation."

Nitrous oxide is most useful for brief, minimally invasive procedures, however, and not every child will like it. But Hollman says the positives usually outweigh the negatives.

"It works really well for 90 to 95 percent of children whom we identify as potentially benefiting from nitrous," he says. "While nitrous oxide isn't for everyone, we felt there were certain patient populations where we could administer it safely and effectively, give them a drug that wouldn't require an IV or taking anything by mouth, and allow them to go home as soon as the procedure is completed. This is just another tool in our toolbox to provide comfort to children."